Temporal relationship between antibiotic use and respiratory virus activities in the Republic of Korea: a time-series analysis

Sukhyun Ryu, Sojung Kim, Bryan I. Kim, Eili Y. Klein, Young Kyung Yoon, Byung Chul Chun

    Research output: Contribution to journalArticlepeer-review

    12 Citations (Scopus)


    Background: Inappropriate use of antibiotics increases resistance and reduces their effectiveness. Despite evidence-based guidelines, antibiotics are still commonly used to treat infections likely caused by respiratory viruses. In this study, we examined the temporal relationships between antibiotic usage and respiratory infections in the Republic of Korea. Methods: The number of monthly antibiotic prescriptions and the incidence of acute respiratory tract infections between 2010 and 2015 at all primary care clinics were obtained from the Korean Health Insurance Review and Assessment Service. The monthly detection rates of respiratory viruses, including adenovirus, respiratory syncytial virus, influenza virus, human coronavirus, and human rhinovirus, were collected from Korea Centers for Disease Control and Prevention. Cross-correlation analysis was conducted to quantify the temporal relationship between antibiotic use and respiratory virus activities as well as respiratory infections in primary clinics. Results: The monthly use of different classes of antibiotic, including penicillins, other beta-lactam antibacterials, macrolides and quinolones, was significantly correlated with influenza virus activity. These correlations peaked at the 0-month lag with cross-correlation coefficients of 0.45 (p < 0.01), 0.46 (p < 0.01), 0.40 (p < 0.01), and 0.35 (< 0.01), respectively. Furthermore, a significant correlation was found between acute bronchitis and antibiotics, including penicillin (0.73, p < 0.01), macrolides (0.74, p < 0.01), and quinolones (0.45, p < 0.01), at the 0-month lag. Conclusions: Our findings suggest that there is a significant temporal relationship between influenza virus activity and antibiotic use in primary clinics. This relationship indicates that interventions aimed at reducing influenza cases in addition to effort to discourage the prescription of antibiotics by physicians may help to decrease unnecessary antibiotic consumption.

    Original languageEnglish
    Article number56
    JournalAntimicrobial resistance and infection control
    Issue number1
    Publication statusPublished - 2018 Dec

    Bibliographical note

    Funding Information:
    This work was conducted in partial fulfillment of the doctoral thesis requirement of the Graduate School of Public Health, Korea University, Seoul, Korea. This work was supported by the Research Institute for Healthcare Policy, KMA in 2016.

    Publisher Copyright:
    © 2018, The Author(s).


    • Antibiotic use
    • Influenza
    • Korea
    • Respiratory virus
    • Time-series analysis

    ASJC Scopus subject areas

    • Public Health, Environmental and Occupational Health
    • Microbiology (medical)
    • Infectious Diseases
    • Pharmacology (medical)


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